Oct 15, 2007 - access to abortion services. The abortion debate has been conceptualised as a conflict between the rights of women and the rights of foetuses.
Pre-Publication version Published: Julie Palmer (2009). Seeing and Knowing: Ultrasound Images in the Contemporary Abortion Debate. Feminist Theory 10(2): 173-189.
Seeing and Knowing: Ultrasound Images in the Contemporary Abortion Debate.
Abstract This article explores the recent arguments in favour of reducing the gestational time limit for abortion based on advances in ultrasound imaging technology. Reading two snapshots from the recent UK debate – a 2004 television interview with obstetrician Stuart Campbell and evidence given to the Science and Technology Committee in 2007 – I draw on the work of Frosh (2001) to examine the conflation of seeing and knowing at work in the texts. I argue that contemporary arguments that 3D and 4D sonography tell us something new about the morality of abortion are based in a contested conflation of seeing with knowing. The image producer is legitimated so long as s/he acts on behalf of the sovereign viewer who has a right to see/know. In addition, I argue that the concerned citizen is called upon to exercise a duty to see/know in order to make a decision about the legality of abortion. Keywords sonography, 3D sonography, abortion, visual, foetal imaging, medical imaging
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Introduction Foetal images of various kinds have played a major role in the abortion debates of the late twentieth-century and a strong tradition of interdisciplinary feminist scholarship has focused on the social and political repercussions of the iconic status of the public foetus (Petchesky, 1987, Franklin, 1991, Taylor, 1992, Duden, 1993, Stabile, 1994, Haraway, 1997, Hartouni, 1997, Morgan and Michaels, 1999). New three- and fourdimensional ultrasound images have been at the heart of the most recent moral and political debates around abortion. Striking portraits of ‘smiling’ foetuses have become increasingly common in the British media since 2003 (Lee, 13 September 2003, Palmer, 2008), more or less explicitly linked with calls to re-assess the gestational time limit for terminating pregnancy. The images have also been noted by politicians who have debated their relevance to the issue. The images are clearly emotive but the issue at stake in the debate about abortion is the extent to which they provide new information about foetal development, foetal sentience, and the morality of abortion. Lines of argument currently emerging in the UK around these images are both familiar and different to those that have gone before. It is important to examine the rhetorical devices at work in the public discourses around such pictures, continue to make use of the feminist scholarship in this area, and respond to new technological capabilities in order to challenge moves to restrict access to abortion services. The abortion debate has been conceptualised as a conflict between the rights of women and the rights of foetuses. Foetal images enable a visual and discursive separation of women and foetuses, depicting the foetus as if floating in space, disconnected from the pregnant body and from the social, political and economic context of pregnancy (Petchesky, 1987, Stabile, 1994). However, I want to suggest that
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recent constructions of the issue suggest a third subject with rights and responsibilities – a concerned citizen who has a right and a duty to know the facts and to form an opinion on the morality of the issue. I am wary of overstating the novelty of this subject position. Berlant has argued that the foetus is imputed with self-identity, a voice, and consciousness in order, in part, to show that it is a ‘contingent being, dependent on the capacity of Americans to hear as citizens its cries for dignity of the body, its complaints at national injustice’ (Berlant, 1994: 151). However, my intention is to further investigate the way that the citizen as viewer of foetal images is imagined, and used as a rhetorical device in contemporary debates and so to argue that threeand four-dimensional sonograms have a significant role in the abortion debate. In order to do this, I draw on Frosh’s notion of the ‘citizen-voyeur’ (Frosh, 2001) to explore the key features of this subject position. Frosh’s figure of the citizen-voyeur is used to explain ‘the relation between the material viewer and the pubic scopic regime’ (Frosh, 2001: 49). Frosh’s article ‘The Public Eye and the Citizen-Voyeur’ (2001) is a complex treatment of photography in contemporary culture, and specifically the ‘paparazzi’ in the aftermath of Princess Diana’s death, however the key concepts in the paper have a wider applicability. Frosh argues that contemporary culture is characterised by: the systematic commodification of images within a growing and highly competitive market; and the ideological masking of the latter within a liberaldemocratic rhetoric of rights whereby visibility is conflated with access to information and accountability: the public’s right to know becomes the public’s right to see (Frosh, 2001: 47).
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The conflation of seeing with knowing at the core of Frosh’s figure of the ‘citizenvoyeur’ is the main theoretical lens for my treatment of the contemporary abortion debate. The focus here is on two textual snapshots from this time period (2004-2007) which enable an exploration of how this configuration is constructed and contested in the context of reproductive politics. It is not my intention to argue in favour of a particular time-limit for abortion but to deconstruct the rhetorical devices evident in the public debate and, specifically, to examine the claims to authority made for visual evidence. The first example is taken from 2004, when obstetrician and ultrasound pioneer Professor Stuart Campbell made a number of television appearances to argue that three-dimensional sonography should force a review of the abortion law. I will consider in detail an interview that he gave for television documentary My Foetus, broadcast in the UK by Channel 4, and in Australia by ABC, in which he argues that there should be a national reconsideration of the gestational time limit for abortion based on the sonographic images he produces. The second snapshot is taken from evidence heard by UK House of Commons Science and Technology Committee in 2007 when a number of panel members argued unsuccessfully that three-dimensional scan pictures should be included in the scientific evidence for foetal consciousness considered by the committee. However, before turning to these cases I introduce the new ultrasound technology in more detail and in the context of the politics of abortion in the UK.
Introducing three- and four-dimensional ultrasound Three-dimensional (3D) ultrasound, like its two-dimensional predecessor, composes an image by using sound-waves which differentially rebound from bone and tissue. A series of two-dimensional images are digitally recorded and reconstructed into threedimensional data according to geometric information that relates the two-dimensional
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images to each other (Nelson et al., 1999: 13). When the images are updated at short intervals to create the impression of movement, this is referred to as four-dimensional (4D) ultrasound. Three- and four-dimensional scanning is not routinely used in antenatal care as, in many cases, two-dimensional technology remains superior for obtaining most kinds of clinical data, however, it is sometimes used to investigate further when an abnormality such as a cleft palate is suspected, and it is available commercially for non-diagnostic use. However, most importantly here, the images have quickly diffused beyond the clinical setting, into newspapers, television news, and documentaries, to play a role in contemporary political debates around reproductive rights. Three-dimensional ultrasound pictures first appeared in the British popular press in 2003 (Lee, 13 September 2003). However, they truly became high profile on June 29th 2004 when Campbell’s striking three-dimensional sonograms dominated the front pages of many of the national newspapers (Palmer, 2008). Campbell has published widely in the field of ultrasound and obstetrics and has, in recent years, published popular pregnancy guides and made a number of media appearances, showcasing the three- and four-dimensional scans that he offers at his private London clinic and expressing his views on the gestational time limit for abortion. The UK centre-left national newspaper The Guardian covered the story with four foetal faces looking out from an inside page alongside the headline ‘Expert calls for abortion limits’ (Adams, 2004). The Guardian quoted Campbell as saying: ‘The more I study foetuses the more I find it quite distressing to terminate babies who are so advanced in terms of human behaviour’ he said. ‘For normal babies being terminated for social reasons it’s probably unacceptable nowadays
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to be terminating them much after 14 weeks. They can suck their thumbs, they can open their eyes, they can perform complex movements. I think it’s time we got our act together’ (Adams, 2004: 8). Although Campbell claimed expert knowledge from his professional experience of scanning, the images were widely reproduced and the implication of much of the coverage was that the lay viewer could and should see the evidence for themselves. The national press is not the only place that the new ultrasound images have been seen. Pregnancy magazines and local newspapers advertise commercial threedimensional ultrasound with 3D foetal ‘portraits’, and Campbell’s popular pregnancy guides delineate foetal development with illustrations drawn from 3D ultrasound (Campbell, 2004, Campbell, 2005): it is not only the foetus ‘under threat’ that is represented in this way, but these appealing images also have a market in representing wanted pregnancies.
The Political Context The 1967 Abortion Act legalised abortion up to 28 weeks in England, Scotland and Wales (but not Northern Ireland), provided that two doctors agree that to continue the pregnancy would involve injury to the woman’s mental or physical health or pose a risk to her life, or if there is a substantial risk that the child would be born with a mental or physical disability. Although debate around the issue has been ‘muted; since the 1967 Act (Sheldon, 1997: 2), there have been regular parliamentary challenges to abortion legislation since 1967 (The Science and Technology Subgroup, 1991, 148), especially with regard to the grounds for abortion and the gestational time limits, but so far the only amendment has been to revise the time limit down to 24 weeks, with exceptions remaining in the case of grave danger to the life, physical or
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mental health of the woman or evidence of severe foetal abnormality. The number of terminations performed in England and Wales is around 190,000 per year (British Medical Association, 2005) and the percentage of terminations performed over 20 weeks is small (1.6% in the first quarter of 2008 (Office of National Statistics, 2008)).
Recent challenges to the legislation bear resemblance to many of the arguments made at the time of the Alton Bill – a private members bill introduced in 1988 that similarly aimed to reduce the gestational time limit (see Franklin et al., 1991 for a comprehensive account of debates around the Alton Bill). At the present time in the UK, there is a similar focus on ‘social’ abortions’ rather than cases of prenatal diagnosis; there is a renewed focus on ‘late’ abortions – and the definition of ‘late’ is of course crucial to decision-making around the gestational time limit; and the focus of attention is very much of foetal rights rather than women’s reproductive rights. The argument is, once more, that scientific development mandates a reconsideration of the law (Campbell, 2006, Dorries, 2006). In the 1990s, Virginia Bottomly, the Minister for Health, presented the need for reform of the abortion laws as a matter of scientific and medical development. Indeed, David Alton mentioned ultrasound explicitly as a factor in the state of knowledge about foetuses (Sheldon, 1997: 109). In the early years of the twenty-first century, three- and four-dimensional ultrasound is the scientific advancement most often referred to in recent debates although survival rates at earlier gestational ages are also an important issue. The abortion issue has continued to resurface since the media coverage of the summer of 2004, most recently in Parliamentary debates of amendments to the Human Fertilization and Embryology Bill in October 2008. At the core of such debates are questions about ways of knowing.
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What can foetal images tell us about foetal development? How does this relate to the morality of abortion?
Ways of Knowing the Foetus Mainstream discourse routinely naturalises the visualised foetus and reifies it as ‘the truth’ about prenatal existence. The image is presented as if it provides immediate access to the real: a sonogram, like a photograph, has what Sontag refers to as an ‘innocent’ relation with reality (Sontag, 1979: 6) and is therefore seen as an accurate reflection of the world rather than a peculiar construction of the organic foetus, visualised in a particular way. However, feminist theory has challenged such claims to realism. The visualized foetus is constituted within and by the politics of vision. The dominant position in 1980s feminism and cultural theory was that vision ‘necessarily partakes of Cartesian forms of disembodied subjectivity and phallocentric aesthetics’, whereas more recent work has argued that vision is neither inherently good nor bad, but rather the issue of concern is who has the power to render visible and who has the power to look (Waldby, 1998, 373). Ways of seeing are recognised as socially embedded (Hartouni, 1997, 25). Scholars have addressed who is looking and who is being looked at (Mulvey, 1989) and the power of the disciplining gaze (Foucault, 1977) as well as, paradoxically, the dangers of the averted gaze (Haraway, 1997, 203). Further, the hierarchical separation of vision from other senses is questioned and alternative ways of knowing championed. Embodied knowledge has been significant in feminist thinking, emerging as an important issue in the 1970s women’s self-help health movement where women’s knowledge of their own bodies was in direct confrontation with medicine and biomedical science (Rose, 1994). In the case of pregnancy, Barbara
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Duden has noted the replacement of quickening as a landmark moment in pregnancy with ultrasound visualizations (Duden, 1993). Public foetal images are widely critiqued for representing the foetus as separate from the womb, distanced from women’s bodies and the social, political and economic context of pregnancy (Petchesky, 1987, Stabile, 1994). ‘Scientific photography’ has played a crucial role in the medicalization of the abortion debate – the shift from religious to technical arguments against legal abortion (Franklin, 1991). Sheldon argues that the medicalized argument is powerful because ‘scientific knowledges can legitimate and depoliticise’, making political decisions seem ‘neutral or commonsensical’ (Sheldon, 1997: 25). The value of such images is in their claims to furnish the viewer with visual knowledge, a claim that relies on an association between vision and objectivity, as well as between ultrasound and specifically scientific objectivity. However, three-dimensional imagery has a particularly strong claim to ‘commonsense’. Whereas two-dimensional scan pictures are difficult for non-medical audiences to read, the new images are clearer and more immediately comprehensible to the ‘citizen-voyeur’.
Knowing and Seeing the Foetus It is my contention that the arguments currently emerging around three-dimensional ultrasonography can be characterised, in Frosh’s terms, by a conflation of the right to know with the right to see. I aim to draw on Paul Frosh’s work on the ‘citizen-voyeur’, contextualised in feminist theorising around foetal imaging and visual ways of knowing, to examine the assumptions about knowledge and vision that underpin the current calls to review the gestational time limit.
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This strategy relies on an imperfect analogy between sonography and photography. Both are practiced by professionals, only photography is also available to the masses. One is based in a technology of light and the other of sound waves. In both cases, the images produced are read, as traces of something that was once there (Sontag, 1979: 5) but both have a history of imaging things that cannot be seen by the naked eye. Sonography makes the foetus in utero available to both the medical and public gaze; time lapse photography has shown us movement that is either too fast (the galloping horse first imaged by Muybridge in 1878) or too slow (the growth of plants) for the human to see (Szarkowski, 2003). While the medical origins of ultrasound lend it credence, the analogy with photography can be productive in opening medical images to the same kinds of analyses to which photography has long been subjected – analyses that takes into account the process of production, the selection of the frame, the editing of the image, and that critically assess photography’s claims to realism. If we are ‘post-photography’ , that is to say that, in the age of digitalisation we no longer trust the veracity of photographs (Lister, 2003), we are not yet post-sonography. There are two elements to my argument. First, I draw on Frosh’s posited conflation of knowing with seeing in order to make sense of the epistemological underpinnings of many of the arguments made that the gestational time limit for abortion should be reduced as a direct result of advances in imaging technologies. The argument is frequently made that by seeing something, one learns something important and indisputable. The second element is to understand the authority of those who produce ultrasound images in terms of a ‘photographer’ who acts on behalf of the viewer: For as much as the viewer is empowered via the photographer, it is only in the name of the voyeur ‘as citizen’, through the legitimating discourse of public
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information (which masks the underlying necessity of commercial success), that the photographer has any rights at all. Photography, as the agent of public visibility, must be seen to ‘serve’ the sovereign viewer, at which point the roles of voyeur and informed citizen combine (Frosh, 2001: 50). Therefore, the legitimation of the photographer, which is commercially profitable, is dependent on assumptions about the informational value of photographs and the citizens’ right to know and therefore see. It is also based on an assumption that individuals want to look (Frosh, 2001: 49), that is to say a notion of an informed and responsible citizen who exercises their right to know/see. However, Frosh’s ‘citizenvoyeur’ is based in a rather passive model of citizenship. Just what we should do with the information gleaned from visual representations is unclear. It is a notion based in claiming rights rather than undertaking duties. However, in the transposition of the concept to the context of the abortion debate, the duties of the ‘citizen-voyeur’ also come into focus. While the existing feminist literature around foetal images is primarily concerned with the rights of women and the way that these are set in opposition to the rights of foetuses, Frosh’s theories add a consideration of the rights of the viewer, that is to say a public that observes the visualised foetus. This is an analytically useful addition in the context of a national debate about abortion legislation in which ultrasound images play a part. It is my contention here that the figure of the citizen-voyeur, and the conceptualisation of vision and knowledge in which it is embedded, can usefully be applied as a lens to disentangle and to challenge emerging lines of argument in the UK abortion debate that rely on three-dimensional sonography as new evidence in the legal and moral deliberations. In order to do this, I focus on two cases in turn in which
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the significance of ultrasound imagery has been debated and in which the conflation of knowing with seeing has been contested to a greater or lesser extent. I first turn to television documentary My Foetus before attending to evidence submitted to the Science and Technology Committee in 2007.
Ultrasound as evidence for Documentary Television My Foetus (Black, 2004) was broadcast in the UK1 on 20th April 2004 and watched by 1.5 million people (BBC News, 2004). The film is structured around the ostensibly personal journey of the film-maker as she interrogates her own views about abortion, and the viewer is implicitly invited along, and encouraged to test his or her own prochoice credentials alongside Black. The documentary tradition has often addressed social and political issues. The tradition relies on being able to convey a sense of authenticity, a belief that the world is being presented as it really is, often in order that this account might be used to orientate our actions in the world (Nichols, 2001: xiii). Using the ‘objective, but recognised camera’ of documentary (Fiske, 1993, 30), Black produces a kind of ‘reportage’ in which she positions herself and the viewer as ‘witnesses’ (Corner, 2002: 259).
Reviews of the programme were mixed. Pre-transmission media attention readied viewers to be shocked by the imagery of the film. The BBC reported: ‘The images are disturbing. They are difficult to watch, but they do make the viewer face up to what an abortion actually involves’ (Ryan, 20th April 2004). While others suggested that the film did not offer any new material for the debate: ‘We knew it before: we can see it now’ (Ashley, 20th April 2004). A review in the British Medical Journal described the
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It was also broadcast in Australia in August 2004.
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film as ‘superficial’ and ‘one-dimensional’ and blamed this on Black’s focus on imagery (Murphy, 2004: 1021).
Black (who is film-maker, narrator and protagonist) maps the abortion debate with a series of images. As she builds her narrative, Black summarises the anti-abortion position through interviews with individuals, with each interview revolving around associated images: anti-abortion campaigners present photographs of aborted foetuses as they liken abortion to murder, and Stuart Campbell shows Black his three- and four-dimensional ultrasound imagery as he makes the case for a reduction in the gestational time limit for terminations. Having mapped the field, Black contributes to the iconography of the debate by filming an abortion procedure at seven weeks gestation by the manual vacuum aspiration method, and showing the ‘products’ of another abortion. This was the first time that an abortion was shown on British television and it was also the first time some of the photographs of aborted foetuses had been shown. Within the film, Black justifies her decisions about which images to show in terms of the importance of ‘facing facts’. Her documentary is legitimated in the name of a ‘citizen-voyeur’ who has a right to see/know and Black becomes an ‘agent of public visibility’ in service of the ‘sovereign viewer’ (Frosh, 2001).The anti-abortion campaigners in her film see themselves in a similar role, alluding to the dangers of not knowing, which are equated with not looking. For example, Bill Calvin, from the Centre for Bioethical Reform, argues that North Americans are in denial and that his huge campaign posters showing aborted foetuses, displayed on the side of trucks, make it harder for people to ignore the issue and harder for them to think that abortion is acceptable. In the UK, Fiona Pinto argues that women are victims of
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abortion, manipulated and misled by doctors, and to see photographs of aborted foetuses is to know the truth. In the context of the film, Black re-presents these graphic photographs of aborted foetuses in order to show that she can look and remain pro-choice. She enacts not only the right to see but a duty to look. In this way she denies denial, and gives viewers an opportunity to do the same. However, she is less readily able to dismiss the three-dimensional scan pictures shown to her by Campbell, designating them the ‘ultimate’ images in this debate: As I watch my 34-week-old foetus sleeping in my womb, I realise that for me this is the ultimate image in the abortion debate…The images Bill and Fiona use somehow dehumanise the foetus. Whilst I am repulsed, I am not converted. But if anything could persuade me that destroying a foetus is perhaps wrong it is this technology (Black, 2004, my transcript). I focus on this scene in the documentary, in order to consider the conflation of seeing and knowing in this case. I argue that Black’ difficulty with contesting these pictures lies in the connection she establishes between seeing and knowing throughout the film but note that ultimately she is not convinced by these pictures largely due to recontextualising them in their social and political context. The Ultimate Image in the abortion debate? As Black’s interview with Campbell begins, a series of 3D images fill the television screen, framed in black, labelled 9, 12, 18, 23 weeks. The foetus develops quickly before our eyes, showing us the various stages at which a pregnancy may still be legally terminated. As we are returned to footage of the examination room, we see Black and Campbell looking together at a monitor displaying 3D pictures. Campbell speaks to the screen:
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Campbell: Look at this baby, you know, look at its fingers and its… Black: Yeah, it’s hard to look at that and say it’s not a baby. It’s hard to use the word foetus. Campbell: Yeah. That’s right. Black: You say you were pro-choice but your views are changing? Campbell:…they are changing. We have to have the right policies, allowing choice for women, ‘cause I am pro-choice, at the same time recognising that we have a baby inside the uterus I think at the moment society shouldn’t be too comfortable with terminating a child which looks like a baby, it’s sucking its thumb like a baby. It’s got complex movements and I think we should have second thoughts about it. I begin to think really that for social terminations of pregnancy, 12 weeks should be the limit.
Campbell here makes a very sparse argument against certain kinds of abortions that is based entirely on the ultrasound imaging that he has pioneered. The meaning of the term ‘social abortions’ is left unexplained. I think he is seeking to separate the issues of abortion after prenatal diagnosis from abortion in the case of risk to a woman’s physical or mental health from continuing the pregnancy, however, he also risks drawing on cultural anxieties that women’s reasons for terminating a pregnancy make not be ‘good enough’. Campbell calls upon ‘society’ to make a new decision about the gestational time limit for terminating a pregnancy, based on the visual evidence that he presents and bears witness to.
For Campbell, watching 3D and 4D sonograms produces a moment of recognition of foetuses as babies: the images seem to display baby-like behaviour. Campbell’s language is reminiscent of explicitly anti-abortion rhetoric which metonymically
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displaces foetuses with ‘babies’, or the ‘unborn child’ (Condit, 1990: 82). Despite the emotive tone of his message, Campbell remains the ‘biomedical expert’ who acts as gatekeeper to visual evidence of foetal personhood that relies on high technology. Campbell demonstrates the technology to a socially concerned viewing public who have a right to see what he has seen and so to know what he knows.
In fact, Campbell’s rhetoric is interesting in that it both relies on his ‘expert’ status and evokes the ability of citizen-voyeurs to make informed decisions on the basis of the visual evidence presented. Campbell seems to stop himself expanding on his point: ‘look at its fingers and its…’ The sentence is never completed; rather, Campbell waits for the viewer to draw their own conclusions from the images: the implication is that they are self-evident. While the expert testimony serves to fix the meaning of the images on the screen, the appeal to the viewer relies on the emotive quality of the new images and their clarity. Whereas pro-life films that have used two-dimensional ultrasound have often relied on elaborate narratives provided by experts to guide the viewer around the image and to make sense of the blurry sonograms (see Petchesky, 1987, Boucher, 2004), three-dimensional scans can be left to stand alone, as the expectation is that a lay audience is able to read them, arguably as well as the experts. Of course, Lennart Nilsson’s widely reproduced photographs and foetoscopy pictures are similarly accessible to the untrained eye, but 3D ultrasound draws on a stronger association with clinical practice. Campbell encounters such images regularly in his work as an obstetrician in a London clinic and part of the weight of his claim comes from the repeated viewings that make him an expert. Interestingly, it is his experience as a viewer rather than his skill in producing such images that is the source of his authority. The technical skills and the time needed to produce such clear images is hidden from view.
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Elsewhere in the film, Black uses her position as narrator to respond to the interviewees and often undermine the arguments they make against abortion. Her response to Campbell is less robust. She resorts to facts and figures, reminding us that ‘The reality is that 87% of abortions are carried out in the first 12 weeks’ before moving on to critique a ‘patronising and out of date’ law that means women must convince two doctors that a pregnancy is a threat to her mental or physical health before she can proceed with a termination. Ultimately, Black concludes that the debate is full of ‘emotional contradictions’, arguing that she understands the significance of terminating her first pregnancy but also the huge responsibility of bringing up her new baby. Bringing women’s experiences back into view – a strategy commonly advocated by feminist scholars and activists (Petchesky, 1987, Stabile, 1994) - is the way in which Black retains her pro-choice position in the face of 3D sonograms.
It seems to me that her rhetorical difficulties lie in the fact that her project is based in an assumption that seeing is knowing. The overarching theme of the film can be seen as the association of fact, realism, reality and truth (in opposition to denial, emotion, secrecy, and hiding) with the visual. As a response to anti-abortion groups’ claims of a ‘cover-up’, Black aims to ‘lift the veil of secrecy…and face the facts’: she concludes the film with the words: ‘no more secrets’ (Black, 2004, my transcript) and urges that the debate begin in earnest with the facts in full view. In this construction, the ‘facts’ demand our attention, and to refuse to look is to weaken your position. The duty of citizens as active participants in society now includes the duty to see.
The second example is taken from the debates before the Science and Technology Committee about whether 3D and 4D ultrasound should be admissible as scientific
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evidence as parliament reconsidered the gestational time limit for abortion. In this context, the information value of sonography was more strongly challenged and the following section focuses on the ways that seeing was disentangled from knowing by some of the experts called.
Ultrasound as parliamentary evidence. In 2007 the Science and Technology Committee considered expert witness testimony on scientific developments relating to the Abortion Act 1967. The committee focused on the scientific and medical developments since the Act became law, attempting to exclude purely ethical or moral arguments. Witnesses were invited to comment on three points, among them the scientific and medical evidence relating to the 24-week upper time limit (applicable to most pregnancies) (House of Commons Science and Technology Committee, 2007a). Within this, the committee identified three key considerations: ‘neonatal survival rates and foetal viability, foetal consciousness and pain, and the reasons why women present for late abortions’ (House of Commons Science and Technology Committee, 2007a: 17). Four-dimensional ultrasound was considered by the committee as potential evidence in the issue of foetal consciousness. A number of witnesses referred to developments in ultrasound technology and Campbell’s work specifically.
The committee concluded: While 4D imaging is a useful technology in terms of identifying anatomical abnormalities, there have been no published scientific papers marking a contribution of 4D images to the scientific understanding of neurobiology of foetal development and consciousness (House of Commons Science and Technology Committee, 2007a: 26).
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Despite the fact that the committee excluded the new sonograms from the scientific evidence, the exchanges between committee members and experts is interesting to examine for a sense of the terms of the debate and in order to analyse the ways that the conflation of seeing and knowing is mobilised by some and contested by others. As Steinberg has argued, even unsuccessful attempts to change legislation can shift the terms of debate and therefore warrant analytical attention (Steinberg, 1991).
The following analysis draws on evidence heard by the committee on October 15th 2007, the committee. A panel of experts were asked whether anything relevant could be learnt from 4D ultrasound. Changing public opinion is presented as a reason to reconsider the gestational time limit – a generalised citizen-voyeur who sees these pictures and therefore knows something new about foetal development is called upon to demand a consideration of the visual evidence. However, some of the speakers also present themselves as citizen-voyeurs, as representative citizens who have seen 3D sonograms and therefore know something that might add to the debate of the scientific evidence. However, these rhetorical constructions did not go unchallenged.
Ultrasound and Public Perceptions Dr. Spink: Would the panel accept that 4D imaging has brought about or is starting to bring about a sea change in public attitude to abortion since they can now see the child developing at 18 and 20 and 22 weeks in a way that they had not perceived before when they were thinking about foetuses rather than real children with real limbs, fingers and finger nails, forming a relationship with their mother, listening to their mother’s voice, even at that stage? (House of Commons Science and Technology Committee, 2007b: 11)
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Disputing panel members’ views that ultrasound is irrelevant to the issues at hand, MP [Con] and committee member Bob Spink calls upon a notion of public opinion to reinforce an interpretation of the visualised foetus as ‘child’. According to Spink, ultrasound advances have shown the public – a public made up of citizen-voyeurs that foetuses are ‘children’ - erasing any distinction between prenatal and neonatal existence - and it does this by illustrating certain physiological features – fingers and finger nails – which are somehow smoothly extrapolated to infer a conscious individual who is building a relationship with a woman who is already ‘mother’. Both Dr. Guthrie and Jane Fisher were asked to respond:
Dr. Guthrie: Certainly there is public debate. I am a clinician. My job I suppose is to interpret the science to the women that I see in the clinic. My women are certainly a lot more, shall we say, informed and they are asking a lot more questions than they used to do. That has not reduced the number of women seeking abortions. There is something about, yes, there is more knowledge or we think we have knowledge or we have clues. How do we interpret them?...Despite what women know, it is very interesting that the demand is still there. Jane Fisher: They do provide what are quite memorable images of a developing baby but what has muddied the waters is people thinking we can get clinical information from those images and it is important to make that distinction. Yes the images may be very beautiful but they are not necessarily adding any more to clinical information about developing babies (House of Commons Science and Technology Committee, 2007b: 11).
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Guthrie and Fisher effect a separation of knowledge from emotion from decisionmaking that acknowledges the power of 4D sonography but rationalises the precise nature of its social and political effects. The first rhetorical move made by Guthrie is to create a division between public opinion and her clinical experience. Rather than a generalised public, she speaks about the women she meets in her clinic and the effects of the posited changing social climate on them. She does not challenge the citizen’s right to see but positions herself as the expert who is necessary to interpret ultrasound images. Whereas for Campbell, ultrasound images generate relative certainty, Guthrie argues that such pictures in the public domain generate questions for the women who attend her clinic. Further Fisher locates the impact of sonograms in their ‘beauty’; the striking and memorable nature of the images is seen to confuse rather than clarify the issue.
However, Guthrie struggles to define the public knowledge resulting from threedimensional ultrasound: it is a kind of knowledge or the illusion of knowledge or perhaps just a clue. We might connect this with Susan Sontag’s argument that, for most people, photographs have very little informational value but, rather, they are ‘invitations to deduction, speculation, and fantasy’ (Sontag, 1979: 23). While sonograms are perhaps expected to have more fixed meanings due to their origins in medical science, it is possible to assert that the cultural value of ultrasound images is not in the information they provide (there is no straightforward relationship between the image and its subject); rather, the image is material for interpretation. In this sense, the rhetorical strategies of Guthrie and Fisher function to (re)locate ultrasound at the boundaries of media spectacle and clinical practice that Petchesky has suggested is their proper place (Petchesky, 1987).
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The panel continued to discuss whether 3- and 4D sonography could tell them anything about foetal pain perception, with experts testifying that ultrasound could not advance understanding of the workings of the developing nervous system. Committee member and MP [Con] Nadine Dorries then outlined a contradictory study before making the following point:
Mrs. Dorries: if we do not know, is it not more humane and preferable that we come down on the side of the foetus and assume that the foetus can feel? I ask this for a very specific reason. I was present at two 4D screenings recently, one where a needle was inserted into the abdomen of the mother and the baby physically recoiled from the needle on the screening, and the other one where a baby was simply nudged and pressed in order to change position. The baby obviously was pulling faces and did not want to do it. Having witnessed both those 4D screenings of both those babies, one was very aware of a needle coming at it and the other was very aware that its position was being changed. If it was deeply asleep and unconscious, how was this foetus aware of what was going on in utero? (House of Commons Science and Technology Committee, 2007b: 12)
Dorries’ line of argument is to introduce an element of uncertainty in the scientific evidence and then to introduce her personal experience as a source of clarity or guidance. Attention is shifted from what ‘we’ – society, the scientific community – know to what she – citizen-voyeur - has seen. Dorries draws on anecdotes of personal experience to make the point that ultrasound can depict foetal consciousness. The
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body of the woman undergoing the procedures is almost absent from the account and Dorries recounts an interchange between herself and the foetus. In Dorries’ view, she sees a ‘baby’ and the movements on the screen are interpreted as signs of conscious movement and of volition. She has seen for herself.
Fitzgerald’s response is to explain the difference between reflexes and consciousness and to appeal to reason: ‘we have to be quite rational about this’ (House of Commons Science and Technology Committee, 2007b: 12). She argues:
Professor Fitzgerald: I am trying to give you a rational argument. If we do not know something, we have to use a rational, scientific approach to this...They are very organised, sophisticated reflexes. They give you an emotional reaction. They would give me an emotional reaction. You look at them and you construct something out of them. The foetus is not conscious – that is what I believe – because its brain is not connected together (House of Commons Science and Technology Committee, 2007b: 12).
Fitzgerald acknowledges the emotive power of the images but relocates emotion and consciousness in the viewer rather than the foetus. She separates out vision from reason in order to counter Dorries’ claims to see/know: you may have an emotional reaction to such images but this is no substitute for scientific evidence. These two dialogues have in common a claim on behalf of a citizen-voyeur – in the first case represented as a generalised public opinion, and in the second represented through a personal story of seeing/knowing. The argument is that concerned citizens
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(rather than clinicians) have seen the new details of foetal physiology and movement and therefore know something that should be taken into account. The exact nature of this knowledge is often left implicit and this lack of clarity about exactly what is known/seen is the space in which such claims can be challenged.
Contesting Seeing/Knowing In my first case, the ambiguity about what is seen/known enabled an appeal to ‘commonsense’ – citizen-voyeurs might see for themselves the evidence from ultrasound. Campbell left his thoughts unfinished but appealed to the viewer to react to the images on the screen. However, in the very different context of parliamentary debate the criteria for credibility are different. Medically trained experts giving evidence to the committee recognise the emotive impact of the images but claim their role in interpreting them in the light of published papers and scientific studies. Attempts to solidify the value of 3D ultrasound by claiming it as evidence of foetal consciousness have so far proved unsuccessful due to a lack of conclusive research evidence to connect ‘smiling’ foetuses with sentience or pain perception. Despite the apparent success of the strategy of separating emotion from reason in the parliamentary context, a feminist perspective might problematise this. There is a risk of reinforcing a hierarchical binary between reason and emotion. Emotionality has tended to be associated with women rather than men and interpreted as a sign of being closer to nature, that is to say less ‘civilised’ (Ahmed, 2004: 3). Feminism itself has sometimes been associated with pathological and excess emotionality (Ahmed, 2004: 170). The projection of emotion onto the bodies of ‘others’ functions to exclude others from the realm of reason but also to conceal the emotional elements of rationality (Ahmed, 2004: 170). The expectation that public debate should be purely rational is unrealistic and not necessarily desirable. As Plummer has argued, emotion
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is central to public debates: ‘the public sphere is rarely that hallowed site of neutrality, objectivity, and reason that some have claimed it to be’ (Plummer, 2003: 90). In addition, the separation of public perceptions from clinical opinion risks reifying science as objective and rational. Feminists have long challenged the problematic association of science with objectivity and rationality, even challenging how achievable and desirable objectivity might be (Harding, 1986, Harding, 1991, Haraway, 1997, Haraway, 1991). However, attempts by Spink and Dorries to include lay interpretations of sonograms within scientific evidence, and to claim these as evidence in favour of further legal restrictions to abortion are troubling. In the context of the Science and Technology Committee, stark contrasts between their emotions and beliefs when faced with sonograms as evidence are placed in an uncomfortable hierarchy with scientific knowledge. However, it seems certain that their attempts to include emotional and personal reactions to sonograms in the realm of scientific advancement is intended to make political capital from the reassuring certainties science is perceived to bring. A further rhetorical separation of reason and emotion from decision-making is produced by those seeking to exclude ultrasound from scientific evidence. Guthrie argues that regardless of the effects of sonography on public knowledge and emotions, some women still seek to terminate their pregnancies at her clinic. Similarly, Black ‘faces the facts’ of abortion, including 3D ultrasound pictures, and still defends her decision to terminate an earlier pregnancy. It might be important to maintain a sense of the interrelationship between reason, emotion and decision-making but the rhetorical separation of these three creates space for considering women’s experiences and agency. It is not that those who defend legal abortion are uninformed, or
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misinformed, or that they are callous, or that they necessarily deny the appealing nature of these images. Foetal images, however beautiful or ugly, will not negate the social and political context in which access to safe and legal abortion is needed. Exploring the conflation of knowing with seeing, and the rights and duties of those that see/know adds to the feminist literature a consideration of the rights of the viewer of foetal images. This might seem a risky move if we consider that women’s rights and foetal rights are more usually considered to be at stake. However, it is also a risk to leave unanswered the prevalent claims that a socially concerned citizenship have the right to see/know foetal development through the lens of the latest ultrasound technology and therefore a right to mobilise this knowledge in political decision-making as both ‘commonsense’ and ‘scientific truth’. Visual ways of knowing about foetal development are profoundly problematic as technological visualisations routinely erase pregnant women from view as well as the social, political and economic context of pregnancy. The citizen-voyeur evoked in this discourse is not asked to contribute to the welfare state for example. One way of challenging the new foetal imagery is to dispute the extent to which the viewer is empowered by the act of the ‘photographer’/sonographer and to problematise the conflating of seeing and knowing.
Acknowledgements I would like to extend thanks to the Centre for Women’s Studies at the University of York and to Ann Kaloski for their support of my PhD research from which this article is drawn. My gratitude also to the Arts and Humanities Research Council (AHRC) for funding my doctoral research. Thanks also to Frances Griffiths for comments on an earlier draft.
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